Validation of a multilocus genotyping scheme for subtyping Cryptosporidium parvum for epidemiological purposes

Multilocus Variable-Number Tandem-Repeat Analysis as an Investigation Tool in Cryptosporidium parvum Outbreaks in Finland and Sweden in 2022

Cryptosporidium is a significant cause of foodborne outbreaks. The 60 kDa glycoprotein gene (gp60) is most often used for subtyping Cryptosporidium species but is not always sufficient for defining clusters and infections sources. The Multilocus Variable-Number Tandem-Repeat Analysis (MLVA) scheme has been developed to better differentiate between subtypes. A cryptosporidiosis outbreak, with 35 cases, was detected in Finland in September 2022. At the same time, in Sweden, three cryptosporidiosis outbreaks, with 107 cases, were detected, leading to international collaboration. In both countries, salad mixes were suspected as being the outbreak source. In the Finnish outbreak, the suspected salad mixes were produced in Sweden. In the Swedish outbreaks, salad mixes from two different producers were suspected. Twenty-nine patient samples which were positive for Cryptosporidium parvum (11 from Finland and 18 from Sweden) were sent for MLVA. The Finnish outbreak samples had different gp60 subtypes and MLVA profiles compared to the Swedish samples. In our investigation, MLVA differentiated C. parvum subtypes in more detail than gp60 typing. MLVA suggested no connection between the Finnish and Swedish outbreaks. A traceback investigation supported this conclusion. To detect outbreaks and identify infection sources, the timely subtyping of patient samples is crucial and should be implemented in routine surveillance and outbreak investigations.

Molecular Detection and Characterization of Cryptosporidium spp. and Giardia duodenalis in Dairy Calves from Ningxia, China

PURPOSE

Cryptosporidium spp. and Giardia duodenalis are two important foodborne human and animal parasites that can be disseminated through both food and water, leading to diarrheal disease. Nevertheless, available information on the circumstances of Cryptosporidium and Giardia duodenalis from Ningxia is limited.

METHODS

A total of 208 stool samples of dairy calves derived from large-scale farms (> 1000 heads) of five cities randomly in Ningxia were gathered randomly, were amplified and analyzed by nested PCR based on the three target genes (18S rRNA, gp60 and tpi)and phylogenetic systematics.

RESULTS

The prevalence of cryptosporidiosis and giardiasis in dairy calves in Ningxia were 13.0% (27/208 samples, 95% CI 9.1-18.2%) and 1.9% (4/208, 95% CI 0.8-4.9%) respectively. Three Cryptosporidium species appeared in this study which are Cryptosporidium parvum (C. parvum), Cryptosporidium andersoni (C. andersoni) and Cryptosporidium ryanae (C. ryanae) based on the 18S rRNA gene sequence. IIdA15G1 and IIdA13G1 belonging to the subtypes of Cryptosporidium were detected by the gp60 PCR. The genotypes of Giardia duodenalis were only assemblage E through the amplification of the triosephosphate-isomerase gene (tpi gene).

CONCLUSION

There is a risk of transmission to humans in Ningxia because of zoonotic genotypes (C. parvum, C. andersoni, assemblage E) and subtypes (IId) of Cryptosporidium spp. and G. duodenalis in dairy calves, and it is necessary to pay attention to the disease to prevent a widespread epidemic of the disease with the purpose to protect human and livestock health.

A large cryptosporidiosis outbreak associated with an animal contact event in England: a retrospective cohort study, 2023

Development of gastrointestinal illness after animal contact at petting farms is well described, as are factors such as handwashing and facility design that may modify transmission risk. However, further field evidence on other behaviours and interventions in the context of Cryptosporidium outbreaks linked to animal contact events is needed. Here, we describe a large outbreak of Cryptosporidium parvum (C. parvum) associated with a multi-day lamb petting event in the south-west of England in 2023 and present findings from a cohort study undertaken to investigate factors associated with illness. Detailed exposure questionnaires were distributed to email addresses of 647 single or multiple ticket bookings, and 157 complete responses were received. The outbreak investigation identified 23 laboratory-confirmed primary C. parvum cases. Separately, the cohort study identified 83 cases of cryptosporidiosis-like illness. Associations between illness and entering a lamb petting pen (compared to observing from outside the pen; odds ratio (OR) = 2.28, 95 per cent confidence interval (95% CI) 1.17 to 4.53) and self-reported awareness of diarrhoeal and vomiting disease transmission risk on farm sites at the time of visit (OR = 0.40, 95% CI 0.19 to 0.84) were observed. In a multivariable model adjusted for household clustering, awareness of disease transmission risk remained a significant protective factor (adjusted OR (aOR) = 0.07, 95% CI 0.01 to 0.78). The study demonstrates the likely under-ascertainment of cryptosporidiosis through laboratory surveillance and provides evidence of the impact that public health messaging could have.

Genetic characterisation of Cryptosporidium parvum in dairy cattle and calves during the early stages of a calving season

Cryptosporidium parvum is a causative agent of cryptosporidiosis, an infectious gastroenteritis in neonatal ruminants, which can be fatal in severe cases. The aim of this study was to determine the prevalence of infections in dairy cattle/calves during the early stages of a calving season and the species/genotypes of the Cryptosporidium present. Faecal samples collected from pre- and post-partum dams (n = 224) as well as calves from age ∼1 day onwards (n = 312) were examined. Oocysts were concentrated, DNA extracted and tested by Cryptosporidium 18S rRNA gene PCR and sequencing, while genotypes of C. parvum were determined by gp60 and VNTR analysis. Results showed that 31.3% and 30.4% of pre- and post-partum dams tested positive for Cryptosporidium, respectively. In the adults, C. parvum (n = 52), C. bovis (n = 4) and C. andersoni (n = 19) were identified, while in the calves 248 out of 312 (79.5%) were PCR-positive for C. parvum. The proportion of positive calf samples was significantly higher (P < 0.0001) than the proportion of positive adult cattle during the first seven weeks of the calving season. In adult cattle, three distinct gp60 genotypes were identified, a predominant genotype IIaA15G2R1 (n = 36) and genotypes IIaA15R1 (n = 2) and IIaA14G2R1 (n = 1). In the calves, only genotype IIaA15G2R1 was detected (n = 125). Although C. parvum was observed in adult cattle two weeks after the start of the calving season, the predominant genotypes were not detected until Week 4 in both adults and calves, meaning it is still unclear whether adult cattle are the initial source of C. parvum infections on the farm. Historically calves on this dairy farm demonstrated the IIaA19G2R1 genotype, which, has now clearly been replaced with the IIaA15G2R1 genotype that is now found in both adults and calves. During the study season, significantly higher levels of neonatal calf mortality were observed compared to the seasons before (P = 0.046) and after (P = 0.0002). This study has shown comparable levels of C. parvum infection in both pre- and post-partum dams but higher levels of infection in neonatal calves.

Application of a new multi-locus variable number tandem repeat analysis (MLVA) scheme for the seasonal investigation of Cryptosporidium parvum cases in Wales and the northwest of England, spring 2022

The protozoan Cryptosporidium parvum is an important cause of gastroenteritis in humans and livestock, and cryptosporidiosis outbreaks are common. However, a multi-locus genotyping scheme is not widely adopted. We describe the further development and application of a seven-locus multi-locus variable number of tandem repeats analysis (MLVA) scheme. From 28th March to 31st July 2022, confirmed C. parvum stools (n = 213) from cryptosporidiosis patients (cases) in Wales (n = 95) and the north west of England (n = 118) were tested by MLVA. Typability (defined as alleles identified at all seven loci in a sample) was 81.2% and discriminatory power estimated by Hunter Gaston Discriminatory Index was 0.99. A MLVA profile was constructed from the alleles, expressed in chromosomal order. Profiles were defined as simple (single allele at each locus) or mixed (more than one allele at any locus). A total of 161 MLVA profiles were identified; 13 were mixed, an additional 38 simple profiles contained null records, and 110 were complete simple profiles. A minimum spanning tree was constructed of simple MLVA profiles and those identical at all seven loci defined genetic clusters of cases (here, null records were considered as an allele); 77 cases formed 25 clusters, ranging from two to nine (mode = two) cases. The largest cluster, following epidemiological investigation, signalled a newly-identified outbreak. Two other cases with mixed profiles that contained the outbreak alleles were included in the outbreak investigation. In another epidemiologically-identified outbreak of six initial cases, MLVA detected two additional cases. In a third, small outbreak of three cases, identical MLVA profiles strengthened the microbiological evidence. Review of the performance characteristics of the individual loci and of the seven-locus scheme suggested that two loci might be candidates for review, but a larger dataset over a wider geographical area and longer timeframe will help inform decision-making about the scheme by user laboratories and stakeholders (such as public health agencies). This MLVA scheme is straightforward in use, fast and cheap compared to sequence-based methods, identifies mixed infections, provides an important tool for C. parvum surveillance, and can enhance outbreak investigations and public health action.

Preliminary investigation of a significant national Cryptosporidium exceedance in the United Kingdom, August 2023 and ongoing

Routine laboratory surveillance has identified an unprecedented and ongoing exceedance of Cryptosporidium spp. across the United Kingdom, notably driven by C. hominis transmission, since 14 August 2023. Information from 477 reported cases in England and Wales, followed up with a standardised exposure questionnaire as of 25 September 2023, identified foreign travel in 250 (54%) of 463 respondents and swimming in 234 (66%) of 353 cases. A significant, common exposure has not yet been identified in first analyses.

Changing Molecular Profiles of Human Cryptosporidiosis Cases in Scotland as a Result of the Coronavirus Disease, COVID-19 Pandemic

Cryptosporidium, the most frequently reported parasite in Scotland, causes gastrointestinal illness resulting in diarrhoea, nausea and cramps. Two species are responsible for most cases: Cryptosporidium hominis (C. hominis) and Cryptosporidium parvum (C. parvum). Transmission occurs faecal-orally, through ingestion of contaminated food and water, or direct contact with faeces. In 2020, the COVID-19 pandemic led to global restrictions, including national lockdowns to limit viral transmission. Such interventions led to decreased social mixing, and reduced/no local and international travel, which are factors associated with transmission of multiple communicable diseases, including cryptosporidiosis. This report assessed the impact of the pandemic on Scottish cryptosporidiosis cases, and identified changes in circulating molecular variants of Cryptosporidium species. Molecular data generated using real time PCR and GP60 nested-PCR assays on laboratory-confirmed cryptosporidiosis cases reported during 2018-22 were analysed. The Scottish Microbiology Reference Laboratories (SMiRL), Glasgow, received 774 Cryptosporidium-positive faeces during 2018-22, of which 486 samples were successfully subtyped. During this time period, C. hominis (n = 155; 21%) and C. parvum (n = 572; 77%) were the most commonly detected species. The total number of cases during 2020, which was greatly affected by the pandemic, was markedly lower in comparison to case numbers in the 2 years before and after 2020. The most predominant C. hominis family detected prior to 2020 was the Ib family which shifted to the Ie family during 2022. The most common C. parvum variant during 2018-22 was the IIa family, however a rise in the IId family was observed (n = 6 in 2018 to n = 25 in 2022). The dominant C. hominis subtype IbA10G2, which accounted for 71% of C. hominis subtypes in 2018-19 was superseded by three rare subtypes: IeA11G3T3 (n = 15), IdA16 (n = 8) and IbA9G3 (n = 3) by 2022. Frequently reported C. parvum subtypes in 2018-19 were IIaA15G2R1 and IIaA17G1R1, accounting for 59% of total C. parvum subtypes. By 2022, IIaA15G2R1 remained the most common (n = 28), however three unusual subtypes in Scotland emerged: IIdA24G1 (n = 7), IIaA16G3R1 (n = 7) and IIaA15G1R2 (n = 7). Continuous monitoring of Cryptosporidium variants following the pandemic will be essential to explore further changes and emergence of strains with altered virulence.

First identification of Cryptosporidium parvum virus 1 (CSpV1) in various subtypes of Cryptosporidium parvum from diarrheic calves, lambs and goat kids from France

Cryptosporidium spp. remain a major cause of waterborne diarrhea and illness in developing countries and represent a significant burden to farmers worldwide. Cryptosporidium parvum virus 1 (CSpV1), of the genus Cryspovirus, was first reported to be present in the cytoplasm of C. parvum in 1997. Full-length genome sequences have been obtained from C. parvum from Iowa (Iowa), Kansas (KSU) and China. We aimed at characterizing the genome of CSpV1 from France and used sequence analysis from Cryptosporidium isolates to explore whether CSpV1 genome diversity varies over time, with geographical sampling location, C. parvum genetic diversity, or ruminant host species. A total of 123 fecal samples of cattle, sheep and goats were collected from 17 different French departments (57 diseased animal fecal samples and 66 healthy animal fecal samples). Subtyping analysis of the C. parvum isolates revealed the presence of two zoonotic subtype families IIa and IId. Sequence analysis of CSpV1 revealed that all CSpV1 from France, regardless of the subtype of C. parvum (IIaA15G2R1, IIaA17G2R1 and IIdA18G1R1) are more closely related to CSpV1 from Turkey, and cluster on a distinct branch from CSpV1 collected from C. parvum subtype IIaA15G2R1 from Asia and North America. We also found that samples collected on a given year or successive years in a given location are more likely to host the same subtype of C. parvum and the same CSpV1 strain. Yet, there is no distinct clustering of CSpV1 per French department or ruminants, probably due to trade, and transmission of C. parvum among host species. Our results point towards (i) a close association between CSpV1 movement and C. parvum movement, (ii) recent migrations of C. parvum among distantly located departments and (iii) incidental transmission of C. parvum between ruminants. All together, these results provide insightful information regarding CSpV1 evolution and suggest the virus might be used as an epidemiological tracer for C. parvum. Future studies need to investigate CSpV1's role in C. parvum virulence and on subtype ability to infect different species.

Differences in virulence and oocyst shedding profiles in lambs experimentally infected with different isolates of Cryptosporidium parvum

A wide spectrum of disease severity associated with cryptosporidiosis has been described, ranging from asymptomatic to fatal in both human and animal hosts. The reasons for the variations in severity are likely to be multifactorial, involving environmental, host and parasite factors. This paper describes two experimental infection trials in lambs, a symptomatic host for the parasite, to investigate variation in the clinical manifestations following infection with two distinct isolates of Cryptosporidium parvum. In the first experiment, groups of naïve lambs were challenged with one of two isolates (CP1 or CP2) at ​< ​1 week of age, to test the effect of the isolates on disease outcome. In a second experiment one group of lambs challenged at < 1 week of age (CP1) was then re-challenged with the same isolate at 6 weeks of age (CP1), while a second group was challenged for the first time at 6 weeks of age (CP1). This experiment examined age-related disease symptoms, oocyst shedding and the effect of prior exposure to the parasite on a subsequent homologous challenge. The two isolates were associated with significant differences in the demeanour of the animals and in the numbers of oocysts shed in the faeces. There were also differences in the duration and severity of diarrhoea, though these were not significant. The age of the lamb, at the time of a primary challenge (<1 week or 6 weeks), also resulted in differences in clinical outcomes, with younger lambs showing more severe clinical disease than the older lambs (feeding profiles and presentation of diarrhoea), while older lambs showed virtually no signs of infection but still produced large numbers of oocysts.

An outbreak of Cryptosporidium parvum linked to pasteurised milk from a vending machine in England: a descriptive study, March 2021

We describe the investigations and management of a Cryptosporidium parvum outbreak of linked to consumption of pasteurised milk from a vending machine. Multiple locus variable number of tandem repeats analysis was newly used, confirming that C. parvum detected in human cases was indistinguishable from that in a calf on the farm. This strengthened the evidence for milk from an on-farm vending machine as the source of the outbreak because of post-pasteurisation contamination. Bacteriological indicators of post-pasteurisation contamination persisted after the initial hygiene improvement notice. We propose that on-farm milk vending machines may represent an emerging public health risk.

Foodborne and waterborne parasites at the 2020/2021 European Multicolloquium of Parasitology (EMOP)

This Special Issue in Food and Waterborne Parasitology consists of six articles derived from presentations at the 13th European Multicolloquium of Parasitology (EMOP), that was held in Belgrade, Serbia in October 2021. Within the broad scope of parasitology presented at EMOP 2020/2021, the focus of several sessions, seminars, and presentations was on foodborne and waterborne parasites, with different aspects concerned with Cryptosporidium, Toxoplasma, Trichinella, and Opisthorchis all featuring. Although only a few manuscripts on foodborne and waterborne parasites are presented in this SI, the wide-ranging scope of the articles and, more broadly, of the presentations at EMOP 2020/2021, suggests that the topic of parasites transmitted by food and/or water remains of interest in the European parasitology community. We believe this is likely to be the case for years to come, and the topic is likely to feature prominently in the next (14th) EMOP, scheduled to be held in Poland in 2024. This interest, along with some obvious gaps in the articles on foodborne and waterborne parasites of both European and global importance (such as tapeworms, particularly Echinococcus spp. and Taenia solium), suggests to us that another SI on the subject could be of value as an outcome of the 14th EMOP.